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Cerebellar Mass Lesion

Mass Lesion of Cerebellum


Presentation

  • Methods: Case analysis and literature review Results: A 45-year-old male with no known significant past medical history presented to emergency department due to an episode of severe headache. Patient denied any other associated symptoms.[neurology.org]
  • Handbook of Clinical Neurology: Neuro-Oncology, Part I summarizes the present state of scientific and clinical knowledge in the field of neuro-oncology, including information related to diagnostic techniques such as imaging, along with immunology, molecular[books.google.com]
  • At the time of presentation, the patient may be very ill from severe headache or frequent vomiting due to associated hydrocephalus.[emedicine.medscape.com]
  • No subdural fluid collection or hemorrhage present.[shp.missouri.edu]
  • It is found primarily in adults and typically presents in the fifth or sixth decade, which is substantially older than the age of presentation for medulloblastomas.[clinicalgate.com]
Swelling
  • This can be caused by growth of the tumor itself, swelling in the brain, or blockage of the flow of cerebrospinal fluid.[cancer.org]
  • Acceleration deceleration injuries can cause significant damage to brain tissue and connections causing microscopic swelling.[medicinenet.com]
  • […] consists of: Vermis – the midline structure, named for its “wormlike” appearance Cerebellar Hemispheres Cerebellar Tonsils Important landmark on the inferior surface, which may be herniated secondary to mass lesions of the cerebrum or cerebellum, or brain swelling[brainaacn.org]
Physician
  • It describes an approach for the physician at the bedside to diagnose and treat alterations of consciousness, based on pathophysiologic principles.[books.google.com]
  • In the differential diagnosis of NBD, physicians should take into account the presence of both brainstem and cerebellar and cortical atrophy even in the absence of typical lesions for NBD, particularly in the presence of cognitive dysfunctions.[springermedizin.at]
  • Physicians can find evidence of sensory ataxia during physical examination by having the patient stand with his/her feet together and eyes shut.[howmed.net]
Difficulty Walking
  • […] vestibular dysfunction vertigo, difficulty walking, nystagmus, nausea and vomiting NO dysmetria or ataxia on finger to nose or heel to shin Corticospinal tract dysfunction IPSILATERAL hypotonia & weakness often MISTAKEN for ataxia Impaired proprioception[quizlet.com]
Difficulty Walking
  • […] vestibular dysfunction vertigo, difficulty walking, nystagmus, nausea and vomiting NO dysmetria or ataxia on finger to nose or heel to shin Corticospinal tract dysfunction IPSILATERAL hypotonia & weakness often MISTAKEN for ataxia Impaired proprioception[quizlet.com]
Yawning
  • By Richard Klasco, M.D Photo Credit Ask Well Photo Credit Why Do We Yawn? Reading about yawning makes people yawn. You are probably yawning right now. By Roni Caryn Rabin Latest Search Latest Articles Search Articles 13843 results for sorted by[nytimes.com]
Hypertension
  • Autoregulation maintains cerebral blood flow of 50 cc/100g/min over MAPs ranging from 50 – 150 cc/hr, although in hypertensives this range is shifted upward.[openanesthesia.org]
  • Features of a headache indicating a high risk of a space-occupying lesion of the brain or idiopathic intracranial hypertension include [ 1 ] : A new headache with features suggestive of raised intracranial pressure, including papilloedema, vomiting, posture-related[patient.info]
  • Characteristics Symptom Presentation Headache Nausea Vomiting Ataxia Nystagmus Large Cerebellar Hemorrhages May Cause Hydrocephalus [treated with ventriculostomy] 6th nerve palsies Impaired consciousness Brainstem compression Death Can Occur Secondary To Chronic hypertension[brainaacn.org]
  • Strokes that bleed into the cerebellum, usually hypertensive, can be life threatening and may require surgical decompression. An example of abnormal eye movements from a pontine cavernoma is found here.[dizziness-and-balance.com]
Vascular Disease
  • This thorough, yet concise manual covers the full spectrum of the various categories of neurologic disease, including neoplasia, trauma, vascular disease, and infection, with separate chapters on prion diseases, multiple sclerosis, degenerative disorders[books.google.com]
Headache
  • Methods: Case analysis and literature review Results: A 45-year-old male with no known significant past medical history presented to emergency department due to an episode of severe headache. Patient denied any other associated symptoms.[neurology.org]
  • headache, or headache waking the patient from sleep.[patient.info]
  • At the time of presentation, the patient may be very ill from severe headache or frequent vomiting due to associated hydrocephalus.[emedicine.medscape.com]
  • Increased pressure can lead to general symptoms such as: Headache Nausea Vomiting Blurred vision Balance problems Personality or behavior changes Seizures Drowsiness or even coma Headaches that tend to get worse over time are a common symptom of brain[cancer.org]
  • Call your health care provider if you have regular headaches that occur with nausea, vomiting, or vision changes. Infratentorial brain tumors; Brainstem glioma; Cerebellar tumor Arriaga MA, Brackmann DE. Neoplasms of the posterior fossa.[medlineplus.gov]
Ataxia
  • ataxia Hydrocephalus [which may damage frontopontine pathways] and lesions within the prefrontal cortex — gait abnormalities similar to truncal ataxia Disorders of the spinal cord — gait abnormalities Truncal Ataxia versus Appendicular Ataxia Truncal[brainaacn.org]
  • Sensory ataxia: The term sensory ataxia is employed to indicate ataxia due to loss of proprioception – the loss of sensitivity to the positions of joint and body parts.[howmed.net]
  • They are often called "ataxias". According to Musselman et al (2014), the prevalence of childhood ataxia is 26/100,000 children. Ataxia is rare compared to cerebral palsy (211/100,00) and autism (620/100,000).[dizziness-and-balance.com]
  • This will be due to ataxia involving the lower extremities (not the truncal ataxia with vermis lesions (see below).[casemed.case.edu]
Stroke
  • Richly illustrated throughout, with over 700 images of various neuropathogical diagnoses such as tumor, stroke, infection, degeneration, and malformation among others, this new edition of the classic monograph is an easy-to-use manual for any student,[books.google.com]
  • What was damaged by the stroke? Pt suffered stroke of cerebellum.[quizlet.com]
  • Vascular: Loss of brain cells also occurs with stroke. With ischemic strokes (CVA) blood supply to an area of the brain is lost, brain cells die and the part of the body they control loses its function.[medicinenet.com]
  • Cerebellar hemorrhages more than 3 cm in diameter and cerebellar hemispheric strokes involving more than one third of the hemisphere should be considered for early suboccipital craniotomy with decompression.[ncbi.nlm.nih.gov]
  • […] astrocytomas , medulloblastomas , and ependymomas 6 are encountered in the posterior fossa of younger adults but are rare in older adults, accounting for lymphoma 4 lipoma 4 An important space occupying lesion (the most common in fact) to remember is that of a stroke[radiopaedia.org]
Tremor
  • ., reach past a target, or fall short of the target) • Tremor. The tremor in cerebellar disorders is an action intention tremor (i.e., it is brought out by voluntary movement).[casemed.case.edu]
  • […] tandem gate (be able to walk one foot after the other) Action/intentional tremor tremor that occurs when limb is in motion lesion of ipsilateral lateral hemisphere Titubation (yes or no "shake) tremor of trunk or head lesion of vermis Essential tremor[quizlet.com]
  • A 66 Year old man finds that he has more difficulty in moving about for the past one year. he is annoyed by a tremor in his hands, but the tremor goes away when he performs routine tasks using his hands.[howmed.net]
  • The Romberg test indicates a proprioceptive lesion and is NOT a test of cerebellar function With midline cerebellar lesions, the patient has difficulty standing with eyes open as well as closed [with these lesions, a peculiar tremor of the trunk or head[brainaacn.org]
  • Intention tremors may be present on an attempt to touch an object. A kinetic tremor may be present in motion. The finger-to-nose and heel-to-knee tests are classic tests of hemispheric cerebellar dysfunction.[dizziness-and-balance.com]
Nystagmus
  • R beating nystagmus on R gaze. L beating horizontal nystagmus on L gaze, vertical nystagmus on upgaze.[quizlet.com]
  • . • Nystagmus. Patients often display nystagmus, often bilateral. • Unsteady gait. Patients will have an unsteady gait and a tendency to lean or even fall to the side of the lesion.[casemed.case.edu]
  • The eyes have difficulty maintaining fixation; they drift from the target and then jump back with a corrective saccade, a phenomenon called nystagmus. Disruption of the pathways to the vestibular nuclei may also result in a loss of muscle tone.[howmed.net]
  • This patient was very unsteady and had strong positional nystagmus due to removal of her cerebellar nodulus.[dizziness-and-balance.com]
  • Vertical Nystagmus may occur.[brainaacn.org]

Workup

  • Such a workup should include imaging of the chest (via chest x-ray and/or CT scan of the chest) and also CT of the abdomen and pelvis.[clinicalgate.com]
Brain Edema
  • edema, and the role of stem cells in gliomas.[books.google.com]
  • Medical measures to decrease brain edema should be taken, including elevation of the head of the bed and avoidance of hypo-osmolar solutions, hypercarbia, or hyperthermia.[ncbi.nlm.nih.gov]
  • The median survival of untreated patients, or those treated with corticosteroids alone to reduce brain edema, is about one month (32).[irsa.org]

Treatment

  • With appropriate diagnosis and treatment, coma can often be treated successfully. Conversely, delay in diagnosis and treatment may be lethal. This monograph provides an update on the clinical approach that was laid out in the previous 3 editions.[books.google.com]
  • Furthermore, the book explains the neurological complications of systemic cancer and complications from treatments.[books.google.com]
  • Previous whole brain radiation therapy results have yielded no survival advantage to the treatment.[irsa.org]
  • When specific treatments are available, such as in the Arnold Chiari malformation, they are used when the risk of treatment appears less than leaving the condition alone.[dizziness-and-balance.com]
  • Untreated lesions can be fatal in a few hours, but prompt and appropriate treatment of the mass effect can produce very good outcomes.[ncbi.nlm.nih.gov]

Prognosis

  • It then describes the emergency treatment, both medical and surgical, of patients with specific disorders of consciousness and their prognosis.[books.google.com]
  • These tumors generally have a good prognosis after surgical resection with an 85% to 100% 5-year survival rate. 1, 9, 10 The favorable prognosis in these patients has been attributed to the low-grade nature of cerebellar pilocytic astrocytomas and the[clinicalgate.com]
  • […] edema Radiology images Images hosted on other servers : Right cerebellopontine angle mass Right cerebellar hemisphere mass Prognostic factors Overall favorable clinical outcome with no features of malignant progression but frequent recurrence (50%) Prognosis[pathologyoutlines.com]
  • […] of Clinical Neuroscience. 2013; 20(9): 1193 6 Gamma knife radiosurgery for cranial neurocytomas Ali Genc, Suheyla Uyar Bozkurt, Pinar Karabagli, Askin Seker, Yasar Bayri, Deniz Konya, Turker Kilic Journal of Neuro-Oncology. 2011; 7 Atypia predicting prognosis[ijpmonline.org]
  • Whole Brain Radiation Therapy (WBRT) Brain metastases carry an ominous prognosis regardless of primary status or treatment given.[irsa.org]

Etiology

  • A follow up imaging and investigation for other etiologies are critical. Disclosure: Dr. Tantikittichaikul has nothing to disclose. Dr. Ruthirago has nothing to disclose. Dr. Ali has nothing to disclose. Dr. Claudio has nothing to disclose. Dr.[neurology.org]

Epidemiology

  • Divided into eight sections encompassing 61 chapters, the book begins with an overview of the basic principles of tumors, including the epidemiology of primary central nervous system tumors, angiogenesis and invasion in cancer, the link between blood-brain[books.google.com]
  • Clinical and epidemiological research Tumour-like mass lesion: an under-recognised presentation of primary angiitis of the central nervous system E S Molloy 1 , A B Singhal 2 , L H Calabrese 1 1 Department of Rheumatic and Immunologic Diseases, Cleveland[ard.bmj.com]
  • […] neurolipocytoma, medullocytoma, lipomatous glioneurocytoma First reported in 1978 ( Acta Neuropathol 1978;41:261 ) Considered a mixed neuronal - glial tumor; lipid is apparently due to tumoral lipidization, not adipose metaplasia ( Am J Surg Pathol 2001;25:1551 ) Epidemiology[pathologyoutlines.com]
  • "Gluten ataxia in perspective: epidemiology, genetic susceptibility and clinical characteristics." Brain 126(Pt 3): 685-91. Pittock SJ and others. Paraneoplastic antibodies coexist and predict cancer, not neurological syndrome.[dizziness-and-balance.com]
Sex distribution
Age distribution

Pathophysiology

  • The book begins with a description of the physiology of consciousness and the pathophysiology of disorders of consciousness.[books.google.com]
  • Elderly Nystagmus Nystagmus, pendular Short term memory loss Slow speech Staggering Gait Tic syndrome in a child Habit spasm Tremor Tremor,coarse Unable to tandem walk/straight line Vertigo Macrocephaly/Large head Megalocephaly Walking difficulties PATHOPHYSIOLOGY[howmed.net]

Prevention

  • Measures such as neck compression (tourniquet) and volume loading can be helpful in preventing VAE. PEEP increases the risk of VAE.[openanesthesia.org]
  • We have not found that WBRT leads to a survival benefit nor that it prevents later onset of remote metastases in other brain locations.[irsa.org]
  • Gross total resection and radiation are the most important factors in preventing recurrence, and primary adjuvant chemotherapy has not been shown to have a significant association with survival. 33, 34 However, for high-risk patients, it appears that[clinicalgate.com]

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